Outcomes for systemic therapy in women with ovarian cancer
Introduction
Ovarian cancer is the leading cause of gynecologic cancer death in women. There are 900 women diagnosed annually with ovarian cancer in Ontario, and 50% will die [1]. The management of these women involves surgery in combination with chemotherapy. Other investigators have shown that many women with ovarian cancer do not receive optimal debulking or staging surgery and consequently survival is affected. Tingulstad et al. [2] addressed the effect of institution type on overall survival of women with ovarian cancer. He found that institution type is important in those with advanced disease. In the multivariable analysis, completion of chemotherapy and size of residual disease were independent prognostic variable for survival. There is limited information on the quality of the systemic therapy delivery in ovarian cancer.
We undertook to assess the quality of systemic therapy delivery by evaluating whether structure and process variables impact on survival [3]. Processes of care determine whether what is judged to be good medical care has been applied. Structural variables assess the setting in which medical care is provided. We conducted a population-based study using administrative databases to examine the relationship between survival and volume of systemic therapy for ovarian cancer by physician and institution. As well, we examined the relationship between survival and prescriber specialty and institution characteristics.
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Data sources and elements
This is a population-based cohort study that includes all women with newly diagnosed ovarian cancer treated with systemic therapy in Ontario from January 1, 1996, and December 31, 2002. Any woman who had chemotherapy for ovarian cancer (ICD-9 diagnostic code of 183) was included. Exclusions were particular histology types as defined in the Ontario Cancer Registry (OCR) (i.e., low malignant potential tumors, germ cells tumors, stromal tumors), prior diagnostic code of 183 before January 1, 1996,
Characteristics
A total of 2502 women in Ontario received systemic therapy for newly diagnosed ovarian cancer between 1996 and 2002 (Table 1).
- (i)
Patients. The mean age of patients was 62.7 years. For 12 months prior to the date of surgery, the majority of women (90.4%) had no documentation of other serious comorbid conditions. Eighty-four percent had known metastatic disease. The administrative data and primary chart abstracted data for 1996–1998 were compared such that metastatic in the Charlson score
Discussion
Quality of care has been defined by the Institute of Medicine as the degree to which health services increase the desired outcome and are consistent with current professional knowledge [6]. One approach that has been recently used in the surgical literature is to examine the relationship between volume of a procedure performed in an institution and outcomes in population-based administrative databases. If practice variation is identified which influences survival, the characteristic of these
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